OVERVIEW

Overview
This Report of the Comptroller and Auditor General of India (C&AG)
contains one performance audit and 17 paragraphs relating to suspected
fraudulent/excess payments, unfruitful/avoidable expenditure, fictitious
purchases, irregularities in allotment, lapses in internal control, short/non-
recoveries, shortcomings in implementation of rules and programmes, etc.,
involving `2,809.97 crore. The major findings are mentioned below:

Performance Audit
Department of Health and Family Welfare Services
Arogya Kavacha – 108 Project
Emergency medical services (EMS) is defined as the system that organises all
aspects of care provided to patients in the pre-hospital or out-of-hospital
environment. It is a critical component of health systems and is necessary for
improving outcomes of injuries and other time-sensitive illnesses.
Government of Karnataka aimed to provide a comprehensive Emergency
Response Service, from the time of event occurrence to shifting to an
appropriate hospital, through a single toll free number ‘108’ for which, it had
entered into a Public Private Partnership arrangement (Design, Build, Operate
and Maintain model) with GVK Emergency Management Research Institute,
Secunderabad through a Memorandum of Understanding (MOU).
(Paragraph 2.1.1)
The success of EMS is largely dependent on its responsiveness to emergencies
and the adequacy of the infrastructure in place. The performance audit
conducted for the period 2014-15 to 2018-19 intended to ascertain whether
EMS was appropriately responsive and equipped to deliver quality
pre-hospital emergency care and the Information and Communication
Technology deployed in the project was supporting the overall activities and
the objective of delivering quality emergency care adequately. Though the
project envisaged catering to police, fire and medical emergencies, 99 per cent
of the emergencies attended to were medical emergencies.
(Paragraph 2.1.5)
Audit noticed that EMS fell short of achieving the desired objectives
completely. The project aimed to reach the patients/sites within 20 minutes on
an average in urban areas and 30 minutes on an average in rural areas.
However, rural-urban classification of data was not available. Hence,
maximum 30 minutes’ response time was considered for audit analysis and we
noticed that this was achieved in only 72 per cent of the cases. The response
time comprised triage time, chute time and travel time. The triage time was
more than the stipulated three minutes in 47 per cent of the cases. In 85 per
cent cases, the chute time was more than the stipulated one minute and was up
to 100 minutes and beyond in few cases. Studies indicate that the response
time for cardiac, respiratory and stroke cases was to be less than 10 minutes.
However, the ambulances reached the patients after the stipulated 10 minutes
in 62, 66 and 63 per cent cases respectively. In 50 per cent of the trauma

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cases, the patients were admitted to the hospital after the crucial one-hour
time. In the absence of adequate follow-up data, the impact on the final
outcome of the patients could not be ascertained.
(Paragraph 2.1.9.4 and 2.1.9.5)
The total calls received comprised 64 per cent ineffective calls, out of which
no response and disconnected calls were 42 and 34 per cent respectively. The
callers were called back only in three per cent of the disconnected cases
indicating absence of call monitoring mechanism.
(Paragraph 2.1.9.2)
Pre-arrival instruction is a critical component in EMS. There was no
mechanism in place for alerting the hospitals in advance about arrival of
ambulances. In 18 per cent of the cases, there was a delay in handing over the
patients beyond 15 minutes because of which 1.75 lakh ambulance hours were
lost. This was compounded by the delay in reporting closure of cases by the
crew even after reaching the base station leading to loss of 31.87 lakh
ambulance hours. Ambulances were despatched only in 3.74 lakh cases out of
the 8.87 lakh requests transferred to vehicle busy desk. The allocation of
ambulances was not based on criticality of emergencies as ambulances with
Basic Life Support system were allocated in 75 per cent of the cases to critical
emergencies such as cardiac, respiratory and trauma that required allocation of
Advanced Life Support systems.
(Paragraph 2.1.9.6, 2.1.9.7 and 2.1.10.4)
The project adopted population as the criteria for deployment of ambulances.
In the absence of policy regarding positioning/location of the ambulances, we
observed that ambulances were stationed mainly within the Government
hospital premises and not within the vicinity of black spots. The round trips
undertaken by the ambulances impacts the responsiveness of EMS.
(Paragraph 2.1.10.2)
There were 20 and 21 per cent vacancies in the post of ambulance drivers and
emergency management technicians respectively. The shortage of ambulance
staff led to ambulances remaining off the road for 41,342 days during the audit
period. Emergency Response Centre Physicians (ERCPs) were required to
provide virtual medical directions to EMTs who were in the field. There were
only three ERCPs available at the emergency response centre. The percentage
of unanswered calls by ERCPs was 58.20 and 65.52 during 2017-18 and
2018- 19.
(Paragraph 2.1.15)
There was no strategic management plan to ensure the availability of EMS to
disadvantaged sections such as people living in remote/tribal areas, marine
fishermen etc. In addition, assessment of effective response time for different
categories of emergencies, pre-alerting mechanism, monitoring of patient
outcomes, upgradation of ICT infrastructure and research of effectiveness of
pre-hospital care remained out of the purview of the top management at
Government level.
(Paragraph 2.1.17.1)

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Validation procedures were absent which resulted in incomplete data, back-

end insertion of data and incorrect reporting. Back up plans, incident
management and business continuity plans that were necessary for taking
remedial measures in cases of disruption were not prepared. There were no
reporting arrangements between the Government and the Partner. There were
6,411 complaints received from emergency service users during the audit
period. However, the Government was not informed of the public grievances
by the Partner in the absence of any such mechanism. The State Government
did not have access to project databases, which impaired monitoring of the
project and the use of data to undertake research and development activities
for improving patient care. The State and District level committees, which
were supposed to monitor the project were not constituted.
(Paragraph 2.1.9.9, 2.1.16, 2.1.17.3, 2.1.17.4 and 2.1.17.5)
The Government decided to discontinue the association with the Partner
before the scheduled 10-year period citing deficiencies in services. However,
the existing service provider is continuing as identifying a replacement partner
was delayed. The MOU did not provide for an exit strategy plan for fulfilment
of the contractual obligations as regards transfer of assets and intellectual
property rights. The consequent risk of disruption in implementation of the
project could not be ruled out. The project was also not evaluated despite
being in operation for over a decade.
(Paragraph 2.1.17.2 and 2.1.17.6)
Compliance Audit
Department of Labour
Functioning of Karnataka Building and Other Construction Workers’
Welfare Board
The compliance audit showed that the Board was not able to achieve its
objectives as the number of employers and construction workers registered
with the Board remained low. There was laxity in taking corrective action on
the findings of the previous audit. Absence of adequate checks and balances
at the Board continued to exist and the Board suffered from systemic
deficiencies relating to shortage of staff, poor publicity of schemes, lack of
database, inordinate delays in processing claims, etc.
In spite of having the Expert Committee for advising the Government in
drafting the rules, there were inconsistencies and unrealistic clauses which led
to denial of assistance to construction workers and the Board could utilise only
five per cent of the available funds on welfare schemes during the period from
2014-15 to 2018-19. The absence of internal control mechanism within the
Board resulted in non/short realisation of cess (`27.09 crore), inadmissible
expenditure (`67.98 crore), avoidable liability towards income tax (`2,358.94
crore including penal interest) and non-monitoring of investments, etc.
Majority of the work at the Board was being managed with contractual staff
who even handled cheques/demand drafts and accountability could not be
fixed on them.
(Paragraph 3.1)

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Rural Development and Panchayat Raj Department

Effectiveness of Social Audit
Though provisions of various schemes mandated conduct of Social Audit,
there was no exclusive social authority to oversee the conduct of Social Audit
of schemes implemented in the State. The Social Audit Unit in the State
established exclusively for MGNREGS was entrusted with Social Audit of
other schemes such as NRDWP, SBM, MDM and PDS. However, the Social
Audit of these schemes was not a continuous process as in the case of
MGNREGS. The inaction of the departments concerned on the findings of
Social Audit rendered audit exercise becoming futile.
The Governing body of the SAU had not met regularly which led to absence
of monitoring at the top level. This was coupled with the absence of monthly
reviews by the State Government. Consequently, the follow up on the Social
Audit Reports was weak and less than one per cent of the recoveries pointed
out in Social Audit Reports was recovered. Concurrent Social Audit was also
not conducted as stipulated for want of funds.
(Paragraph 3.2)
Department of Revenue
Suspected fraudulent/excess payment towards purchase of fodder

Doubtful supply of fodder and adoption of incorrect rate for purchase of

fodder by Tahsildar, Kollegal resulted in suspected fraudulent payment of
`9.38 lakh and excess payment of `77.51 lakh respectively to the suppliers.
(Paragraph 3.3)
Department of Medical Education
Fictitious purchase of implants/equipment
The Director of the Koppal Institute of Medical Sciences had issued cheques
worth `64 lakh out of SCP/TSP funds for purchase of implants/equipment
which were never indented or supplied.
(Paragraph 3.4)
Procurement of disposables at higher cost
Failure of the Karnataka Institute of Medical Sciences, Hubballi to finalise its
tender for procurement of disposables within the scheduled time resulted in re-
tendering and additional expenditure of `1.18 crore.
(Paragraph 3.5)
Department of Health and Family Welfare Services
Procurement and utilisation of equipment in district/taluk hospitals
Equipment to all the hospitals, as assessed, was not supplied resulting in non-
achievement of the objective of the Government to establish ICUs in all
district and taluk hospitals. ICUs established at a cost of `98.71 lakh in five

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test checked taluk hospitals and one district hospital were not functional.
Besides, the non-utilisation of various equipment resulted in non-availability
of clinical/diagnostic services to the patients.
(Paragraph 3.6)
Department of Collegiate Education
Exemption of fee concession not extended to girl students of Government
aided private colleges
Non-implementation of the Government order by the Department of
Collegiate Education resulted in collection of `9.68 crore of tuition and
laboratory fee by the Government aided private colleges from the eligible girl
students who were exempted from paying it.
(Paragraph 3.7)
Department of Urban Development
Irregularities in allotment of alternative site
Bengaluru Development Authority allotted and registered 14 alternative sites
without approval of its Board and in violation of statutory provisions. This
resulted in a loss of `10.24 crore to the Authority.
(Paragraph 3.8)
Undue benefit to contractor
Bengaluru Development Authority adopted rates of manual excavation for the
work to be carried out through machinery resulting in extending undue benefit
of `1.92 crore to the contractor.
(Paragraph 3.9)
Lapses in internal control procedure resulted in double refunds
Due to lapses in Bengaluru Development Authority’s internal control
procedure, there were double payment of refunds amounting to `8.55 crore in
307 cases. Though the Authority stated that the entire amount except `12.11
lakh was recovered, it failed to produce recovery particulars for `1.14 crore.
(Paragraph 3.10)
Payments to unauthorised works through false certification
Violation of the provisions of Karnataka Public Works Departmental code by
the Engineers of Bengaluru Development Authority with regard to
measurement book resulted in false certification of fictitious measurements
and led to unauthorised expenditure to the extent of `88.91 lakh.
(Paragraph 3.11)
Avoidable expenditure on road side drains works
Adoption of incorrect item and incorrect rates for road side drain works by
two Bruhat Bengaluru Mahanagara Palike divisions resulted in avoidable
expenditure of `1.09 crore.
(Paragraph 3.12)

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Avoidable expenditure due to non-reduction of quantity of bitumen during

road formation
Non-reduction of quantity of bitumen in bituminous concrete works during
road formation by the Engineering offices of Bruhat Bengaluru Mahanagara
Palike resulted in avoidable expenditure of `82.17 lakh.
(Paragraph 3.13)
Short/non-recovery of royalty
Incorrect computation of royalty on compacted quantities for the various items
of work instead of on actual quantities of minor minerals consumed for works
and application of incorrect rate resulted in short recovery of royalty of
`2.15 crore by Road Infrastructure and Ward divisions, Bruhat Bengaluru
Mahanagara Palike.
(Paragraph 3.14)
Loss of revenue due to non-recovery of property tax
The Assistant Revenue Officer, Gandhinagar sub-division failed to pursue the
recovery of property tax dues towards Kempegowda Metro Station resulting in
non-payment of property tax of `6.76 crore including interest by Bengaluru
Metropolitan Rail Corporation Limited.
(Paragraph 3.15)
Collection of scrutiny fees twice by BBMP resulted in excess collection of
licence fee
Collection of full licence fee without deducting the part of licence fee
collected as scrutiny fee by the Town Planning department of Bruhat
Bengaluru Mahanagara Palike from public resulted in excess collection of
licence fee of `4.05 crore.
(Paragraph 3.16)
Department of Housing
Loss due to incorrect interpretation of guidelines
Incorrect interpretation of the Government guidelines issued for operation of
funds by Karnataka Slum Development Board resulted in loss of interest and
penalty amounting to `1.20 crore.
(Paragraph 3.17)

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